How States Are Addressing the Public Health Crisis of Racism

February 23, 2021 | Adrianna Evans

An increasing body of research finds racism can have a significant impact across one’s lifespan. Research shows that persistent exposure to racial discrimination may result in premature aging, poor health outcomes, and increased prevalence of certain chronic diseases. For example, Black Americans are more likely to have or die from certain chronic diseases, such as asthma, diabetes, and heart disease than white Americans. Black Americans also have a shorter life expectancy than the rest of the U.S. population. These racial disparities are tied to historical racist policies such as redlining and Jim Crow laws, and a legacy of disinvestment in communities of color.

Public and private institutions, school districts, and business leaders are advancing racial equity and supporting policies to address racism. Organizations such as ASTHO, NACCHO, and APHA have issued statements about the need to eliminate the effects of racism. The movement to address racism through policy change is also receiving significant political support throughout the country. At every level of government, policymakers are seeking to acknowledge the systemic oppression of people of color that persists and to elevate racism as an urgent public health crisis comparable to other public health emergencies. At the local level, a growing number of cities and counties are declaring racism a public health issue.

At the state level, governors and legislatures are taking actions to raise awareness of the impacts of racism on health outcomes, to reverse the damage of racist polices, and to promote policy change to prevent the negative effects of racism and discrimination on future health outcomes. Below is an overview of state-level efforts to declare racism a public health crisis, establish political bodies and procedures to assess the disparate impact of current policies on populations of color, and implement policy changes to ensure that future policies are enacted with racial equity in mind.

Racism as a Public Health Crisis

In July 2020, the Minnesota House of Representatives passed HR 1 declaring racism a public health crisis. The resolution calls on the state to dismantle racism by studying existing policies, supporting initiatives that advance equal opportunity, and ensuring that public safety is administered equitably. Several other states introduced similar resolutions declaring racism a public health crisis—California (SB 17), Missouri (HCR 14 and HCR 27), Arizona (SCR 1017), Virginia (HJ 537), Connecticut (SB 55), New York (S 2987 and J 3206), Georgia (HR 78), New Jersey (AR 175), and Tennessee (HJR 10). These resolutions would establish working groups and outline specific measures for jurisdictions to take against the public health crisis (e.g., educating state personnel about how racism impacts individual and population health). This month, Minnesota introduced further legislation (companion bills SF 800 and HF 784) that would appropriate funds to address systemic racism in a number of state programs. While many of proposed declarations have not survived the legislative process, these efforts to address racism illustrate a commitment to create solutions to the crisis. Beyond state legislatures, governors in Michigan, Nevada, and Wisconsin issued executive orders declaring racism as a public health crisis, requiring immediate action and allocation of resources.

Addressing Systemic Racism

Other state legislation has been introduced to investigate or address systemic racism. For example, New Jersey has two sets of companion bills (A 2327 and S 1662; A 711 and S 322) introduced to create two task forces. There’s the Task Force on Institutional Discrimination in Health Care which would “study and evaluate aspects of the institution of health care that may contribute to unequal health outcomes for patients of different races and socioeconomic classes.” And the New Jersey Reparations Task Force which would “conduct research and develop reparatory proposals and recommendations to address the generational harms caused by New Jersey’s role in America’s institution of slavery and its legacy of systemic racial discrimination.”

In Maryland, HB 78 was introduced to create a commission on health equity to examine the impact of various factors (e.g., workplace diversity, public safety, etc.) on residents’ health. In Illinois, HR 25 would urge medical professions to eliminate racism and recognize bias. The Illinois legislature is also considering HB 159 to establish an anti-racism commission and HB 158 to create a racial impact note to analyze the impact of proposed legislation on racial and ethnic minorities. In Washington, SB 5228 would require the inclusion of education on health equity issues in health system in medical trainings. Similarly, Minnesota’s lawmakers are considering companion bills SF 877 and HF 660 to require anti-racism and implicit bias training for health professionals. New Mexico legislators introduced LR 44 requiring state agencies to create policies addressing institutional racism. In addition, governors in North Carolina and Vermont issued executive orders establishing task forces or councils to implement strategies and policies to eliminate racism in several systems including the public health and criminal justice systems.

Public health agencies are well-positioned to lead, galvanize change, and foster collaboration across government sectors, stakeholders, and community organizations to advance racial equity and improve public health. There are many ways state officials can promote and adopt executive and legislative policies, like forming taskforces, enacting meaningful policy change, and strengthening data collection capacities to evaluate and support a policy’s effectiveness.

Moving forward, states can sustain these efforts by allocating funds to programs with a stated goal of eradicating racism. The inclusion of a racial equity lens in policies, practices, cultural norms, and public health programming will work towards combating institutional racism and ultimately improve health outcomes for all citizens. ASTHO will continue to track legislative and executive action on this important public health issue.